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Asylum Patient Joseph U (1870–1916)

by David Roth

* Joseph’s real name has been redacted. As a condition of access to patients’ records, the New South Wales Department of Health has required that I do not give the real names of any patient who died less than 110 years before the date of publication. 

Joseph U (a pseudonym), aged 44, was suffering from a terminal illness, General Paralysis of the Insane (GPI), when admitted to Callan Park Hospital for the Insane in 1914. Modern studies estimate that this condition, a form of neurosyphilis, occurs in about ten per cent of untreated persons who have contracted syphilis. Since the introduction of effective treatments for syphilis, GPI has become a rare condition. Its mental and physical consequences are severe — it is usually fatal within two years. About half of people with early neurosyphilis, namely people whose central nervous system (CNS) has been affected, but do not as yet show external neurological symptoms, develop gummas (lesions) which may severely, and often fatally, affect bone fragility, the cardiovascular system, the skin or other organs. These symptoms also occur with later neurosyphilis. Modern studies indicate that in the pre-antibiotic era, cardiovascular syphilis accounted for ten to fifteen per cent of all clinical cardiovascular disease. GPI patients are thus at double hazard, being at risk of severe organ damage after the relatively mild first stage of the illness. This initial stage is usually characterised by a chancre (a painless ulcer), usually on the genitals. 

My research on Callan Park suggests that one of its major roles, before the advent of successful treatments for GPI and syphilis by the 1920s, was to provide hospice care for these terminally ill patients. There were several reasons for this practice. In addition to crippling physical disabilities, such as paralysis, people who contracted GPI often came to the attention of the authorities by exhibiting disturbing, sometimes violent, behaviour and grandiose delusions. Indeed GPI had been regarded as a mental disorder with physical manifestations until the establishment of the link between GPI and syphilis in the early twentieth century, an association which was finally confirmed via the Wassermann test for syphilis. Public awareness of this association or unmanageable behaviour often resulted in rejection by families. Public hospitals at this period did not accept patients with chronic and incurable conditions and people with GPI could not be imprisoned because mental illness was a defence against criminal charges. Thus mental asylums became their last refuge. About eight to twelve per cent of all people admitted to NSW asylums between 1892 and 1920 were diagnosed with GPI. 

It appears that Joseph was not banished by his second family (he divorced and remarried around 1903) but was soon rejected by the hospital system. His contraction of syphilis around this time was a possible cause of this marriage breakdown. His second wife noticed a marked change in Joseph’s behaviour, beginning about a year before his admission. He became quiet and reserved, often preferring to make signs rather than speak, but still able to work at his occupation of ‘greaser’ (oiler of machinery). A few days before admission to Callan Park, Joseph became too ill too work and was sent to the Sydney Hospital, a public hospital in central Sydney. He did not stay long. It is probable that Joseph had been diagnosed with incurable GPI at the Hospital, because after only two days, he was discharged to the Reception House for the Insane for assessment. After two days at the House, he arrived at Callan Park. 

We do not know much about Joseph’s state of physical health at admission because of the poor state of these records. The scant and scrappy comments on his physical condition were not made on the official ‘Examination of Physical Condition’ form, but on the back of another form. Apart from recording the colour of his hair and eyes, the notes say that his teeth were ‘poor’, and his pupils were of unequal size. But there is no mention of the condition of Joseph’s heart or lungs. From late 1910, it was normal practice to perform the Wassermann test for syphilis on all patients at admission. Joseph tested positive. It is possible that the test was conducted at the Sydney Hospital, resulting in his prompt rejection. 

The admission notes on Joseph’s mental condition and background were somewhat more detailed. We can assume that most of this information was supplied by his family, because he was not able to give any intelligible information about himself, having been admitted in a ‘stuporous, restless’ condition. Joseph had no idea of time or place. When asked about his relatives in London, Joseph was able to say that they had all been killed in an explosion. His gait was unsteady, a typical sign of neurological disorder. He was admitted to Ward Five, the ‘sick/hospital’ ward for males. 

Joseph’s ‘Record of Progress’ notes, like his physical condition records, were also substandard. The 1898 Lunacy Act required that a history of the patient’s case in the hospital should be kept in the case book. Usually observations were made weekly for the first month of admission, and at least once a month after that. But there were numerous instances of large gaps in the observation records, quite often at intervals of years. Joseph’s case is particularly concerning. His last and only observation after admission, and the (re)construction of his history, seems to have been made on the day of his death in early 1916. According to these notes, it appears that he had been a test subject for a new experimental therapy for GPI, the Swift-Ellis treatment. 

At this period there were fairly successful, though toxic and risky, treatments for earlier-stage syphilis, but none for GPI. Salvarsan, an arsenical-based compound, had been used with some success in Australia since about 1910 and its efficacy had been confirmed by the Wassermann test. But it was not effective against GPI, as confirmed by James Flashman, the director of the mental hospital pathology laboratory. While the Wasserman test for these patients showed that the syphilis spirochete had been cleared from the bloodstream, it remained in their cerebro-spinal fluid (CSF), continuing to attack the nervous system and brain. Doctors had found earlier that many drugs could not pass from the blood to the brain due to the blood-brain barrier. Experimental tests which crossed the blood-brain barrier by injecting salvarsan directly into the CSF via lumbar puncture were soon cancelled due to many serious complications, reports of extreme pain, and a high death rate. The Swift-Ellis treatment was thought to be less risky. In this technique, a serum was created from the patient’s own blood after intravenous injection with salvarsan. This serum was then injected into the CSF, allowing it to attack infection in the brain. 

Joseph was a test subject for the Swift-Ellis treatment. It should be noted that lumbar puncture, the method of access to the CSF, is quite painful without anaesthetic, and adverse side effects, such as excruciating headaches, might persist for weeks. There was also a risk of paralysis or fatal infection if the procedure was inexpertly performed. There is no evidence that anaesthetic was used in Joseph’s case. The treatment was continued until March 1915, and he showed a ‘remarkable’ improvement. Although he was still ‘silly and erratic’, he was able to work industriously, his memory improved, and he was thought to be quite trustworthy. As the notes on the front of his folder say: ‘it would have been better if it could have been continued, but war cut off salvarsan supply’. Germany had been the only source of salvarsan until 1916 when it started to be produced in Britain. Around the same time, Alan C (a pseudonym) had also experienced ‘wonderful’ results from the Swift-Ellis treatment, ‘mentally and physically’, but he also declined in health when it had to be stopped. It appears that this therapy was not resumed for other patients once salvarsan supplies were restored, probably because of reports of high death rates and the attendant risks. Despite claims of cure via the Swift-Ellis method, malarial treatment, which also had risks, became more popular in Australia and internationally from the mid-1920s. 

There is no record of any other treatment for Joseph. Indeed it appears that only a few GPI patients received palliative treatments, such as opiates or iodides, at Callan Park, but it is possible that they were simply not recorded, given the often haphazard nature of the case notes. It seems that Joseph became gradually more ‘restless, destructive and dirty [incontinent of faeces]’. His condition worsened — he refused to eat and had to be force-fed, a procedure that was well known to be psychologically and physically distressing. Force-feeding had been used in prison on the imprisoned English suffragettes who went on hunger strike in 1914. Their supporters maintained that it was a means of officially sanctioned torture. Despite the temporary relief for Joseph’s symptoms, his treatment probably did not extend his life, despite its initial promise, and it is evident that he experienced considerable discomfort in his last few years.

Citation details

David Roth, 'Asylum Patient Joseph U (1870–1916)', People Australia, National Centre of Biography, Australian National University, https://peopleaustralia.anu.edu.au/biography/asylum-patient-joseph-u-30545/text37865, accessed 29 March 2024.

© Copyright People Australia, 2012

Life Summary [details]

Birth

1870

Death

1916 (aged ~ 46)
New South Wales, Australia

Cause of Death

syphillis

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